The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain.

Introduction: Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective: The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods: The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results: After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion: The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.

Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience.

Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from - unfortunately, there is no consensus on which treatments are "better" and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.

Neurostimulation for the Treatment of Chronic Head and Facial Pain: A Literature Review.

BACKGROUND: Head and facial pain is a common and often difficult to treat disorder. Routine treatments sometimes fail to provide acceptable relief, leaving the patient searching for something else, including narcotics and surgery. Recently, neuromodulation has been expanding to provide another option. Secondary to its potentially temporary nature and relatively manageable risk profile, several reviews have suggested trialing neuromodulation prior to starting narcotics or invasive permanent surgeries. There is evidence that neuromodulation can make a difference in those patients with intractable severe craniofacial pain. OBJECTIVES: To provide a basic overview of the anatomy, epidemiology, pathophysiology and common treatments of several common head and facial disorders. Furthermore, to demonstrate the suggested mechanisms of neuromodulation and the evidence currently existing for the use of neuromodulation. METHODS: A comprehensive review was performed regarding the available literature through targeting articles reporting on the use of neuromodulation to treat pain of the head and face. RESULTS: We compiled and discuss the current evidence available in treating head and facial pain. The strongest evidence currently for neuromodulation is for occipital nerve stimulation for migraine, transcutaneous vagal nerve stimulation for migraine and cluster headache, sphenopalatine ganglion microstimulation for cluster headache, and transcutaneous supraorbital and supratrochlear nerve stimulation for migraine. In addition, there is moderate evidence for occipital nerve stimulation in treating occipital neuralgia. LIMITATIONS: Neuromodulation has been trialed and is promising in several craniofacial pain disorders; however, there remains a need for large-scale, randomized, placebo-controlled clinical trials to further evaluate the efficacy and safety of most treatments. Much of the current data relies on case reports without randomization or placebo controls. CONCLUSIONS: With advancing techniques and technology, neuromodulation can be promising in treating intractable pain of the head and face. Although more randomized controlled trials are warranted, the current literature supports the use of neuromodulation in intractable craniofacial pain. KEY WORDS: Neuromodulation, headache, facial pain, craniofacial pain, migraine, cluster headache, trigeminal neuralgia, occipital neuralgia, peripheral nerve stimulator, high cervical spinal cord stimulator, peripheral nerve field stimulator.

Review of concentration yields in commercially available platelet-rich plasma (PRP) systems: a call for PRP standardization.

Platelet-rich plasma (PRP) has become increasingly popular in pain medicine with hopes of becoming a safe, effective alternative to routine treatments. However, given its autologous nature, PRP injectate may differ depending on the specific manufacturer and protocol. Currently, there is no standardization of reporting protocol. This systematic review compiles and standardizes values on PRP preparation and final product composition of platelets, white cell count, and growth factors for ease of comparison. On review of 876 studies, 13 studies were selected according to our inclusion criteria. Data from 33 PRP systems and protocols were extracted and standardized. Overall, PRP final product concentrations as well as PRP preparation protocols varied widely between systems. However, platelet concentration was directly correlated with both volume of blood collected and device centrifugal force. In conclusion, there is a large heterogeneity between PRP separation systems that must be resolved for proper study of this promising treatment.